DENVER – Food insecurity at home is an independent predictor of increased risk for conduct disorder in adolescents, according to a large observational study.
This raises the exciting possibility, albeit as yet untested, that food assistance programs in high schools in disadvantaged neighborhoods could help prevent conduct disorder, Dr. Christelle Roustit said at the annual meeting of the American Public Health Association.
This hypothesis dovetails with a new report by Dr. Roustit and her colleagues that food supplementation programs appear to counteract the adverse relationship between food insecurity at home and poor high school academic performance (Pediatrics 2010;126:1174-81). Because academic achievement is a classic stepladder out of a heritage of poverty, these findings suggest that school food supplementation might help dismantle the intergenerational transmission of poverty and social health inequalities, said Dr. Roustit of the University of Paris.
Both the conduct disorder and academic performance studies were cross-sectional. They used the same data set comprised of 2,346 teens and 1,983 parents who participated in the Social and Health Survey of Quebec Children and Adolescents, conducted in 1999.
Among the adolescents, 21% had conduct disorder as defined by meeting at least three of five DSM-IV criteria within the previous 6 months: assault or fighting, cruelty to animals, damage to property, theft or fraud, or serious violation of the law. Conduct disorder was 2.45-fold more prevalent among boys than girls, consistent with findings from other studies.
Just under 10% of teens lived in food-insecure households as determined by affirmation of statements, including: "We eat less than we should because we don’t have enough money for food."
In a multivariate logistic regression analysis adjusted for demographic and socioeconomic variables, home food insecurity was associated with a statistically significant 1.95-fold increased risk of conduct disorder in boys and a nonsignificant 1.49-fold increased risk in girls.
Contributors to home food insecurity included parental occupational status and educational level, family income, and – newly demonstrated in this study – parental psychological distress.
Parents with moderate psychological distress as assessed using the Psychiatric Symptom Index had an adjusted 1.77-fold greater likelihood of having a 16-year-old with conduct disorder than if parental distress were rated as low. Moreover, parents with high-level psychological distress had a 1.87-fold increased risk of having a teen with conduct disorder.
Turning to the study on the relationship between household food insecurity and scholastic performance, Dr. Roustit reported that students having a high level of food insecurity at home were an adjusted 2.2-fold more likely to get below-average grades than students without food insecurity issues. But if the students with at-home food insecurity had a food supplementation program in their high school offering free or reduced-price meals and/or snacks, the link between food insecurity at home and poor academic performance vanished.
Indeed, students with household food insecurity who had a food assistance program in their high school were 41% less likely to get below-average grades than students without food insecurity issues. Although this 41% reduction didn’t achieve statistical significance, it does provide encouraging support for the notion that food assistance programs can reverse the effects of food insecurity.
Similarly, high school students with at-home food insecurity were at 2.1-fold greater risk of repeating a year – unless they went to a school with a food assistance program. In that case, they were 13% less likely to repeat an academic year than students without food insecurity.
"The results of this study suggest that school food assistance or some aspect of it may well help adolescents thrive during the secondary school years and may be part of a successful poverty reduction strategy," Dr. Roustit said.
She noted, however, that this was not a randomized trial, so it’s impossible to state with certainty that school food assistance programs promote improved academic performance by teens with food insecurity at home. Nor does the study shed light on the mechanism of apparent benefit, which might involve a direct effect of enhanced nutritional intake on cognitive function, an indirect effect of nutrition on motivation or attentional status, or reduced school absenteeism because of illnesses related to nutritional deprivation.
Similarly, it’s impossible to determine the extent to which parental psychological distress in food-insecure households contributes to the increased risk of adolescent conduct disorder as opposed to being a consequence of it, Dr. Roustit noted.
She said had no relevant financial disclosures. ☐